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Insurers explain why they opted out of public exchanges

Wellmark, UnitedHealth both took 'wait-and-see' approach to open enrollment

To sell or not to sell? That's the question insurers continue to face as the Affordable Care Act's state insurance exchanges have struggled, recovered and, in some cases, thrived.

Wellmark Blue Cross and Blue Shield opted out of selling plans on the Iowa public exchange for both the first and second open enrollment periods. The insurer based this decision on a number of factors, Wellmark spokeswoman Traci McBee told FierceHealthPayer

"We were concerned about the customer experience. While consumers can expect a relatively smooth experience on the site now, issues still exist with back-end operations for insurers," she said. "Specifically, how data is transferred between the system, health insurers and the many government entities involved in determining eligibility, continue to be problematic."

Additionally, insurers wanted to avoid the uncertainty and risk, even though the federal government established oversight programs for the state exchanged based on the three R's--risk adjustment, reinsurance and risk corridors--said Shaun Greene, chief operating officer of Arches Health Plan and a member of the FierceHealthPayer Advisory Board.

An insurer bases its decision on what is in the best interest of its members, McBee added. For example, Wellmark gave the option to extend non-grandfathered plans into 2016. This let members "choose the plans they want, know and trust while still having the flexibility to move to new ACA plans if those would better meet their needs."

Other insurers took a "wait-and-see" approach during round one but now want to play ball.

Take UnitedHealthcare. In the spring of 2013, when states began publicly releasing data regarding plans and prices to be sold on the exchanges, the insurer was missing from California's list. At the time, UnitedHealth decided to not sell on the marketplaces because CEO Stephen Hemsley was concerned the new consumers may be costlier, FierceHealthPayer previously reported.

Earlier this month, UnitedHealth decided it wanted in--but the board of Covered California rejected a bid from the insurer to sell on the state's exchange in 2016. Covered California's executive director Peter Lee said that insurers are not free to enter the insurance exchange as they please and "undercut" rivals who have been involved since the beginning.

In its latest earnings report, UnitedHealth said it's eyeing a 2017 entry onto the California insurance exchange

Related Articles:
Some big insurers take 'wait-and-see' approach to exchanges
California exchange rejects UnitedHealth
Wellmark opts out of Iowa exchange, citing customer service concerns